Healthcare Provider Details

I. General information

NPI: 1841394384
Provider Name (Legal Business Name): WEST LAWN PODIATRY ASSOC., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STEVENS AVE
WEST LAWN PA
19609-1425
US

IV. Provider business mailing address

25 STEVENS AVE
WEST LAWN PA
19609-1425
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-4581
  • Fax: 610-678-8677
Mailing address:
  • Phone: 610-678-4581
  • Fax: 610-678-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5343070001
License Number StatePA

VIII. Authorized Official

Name: PAUL C. LAFATA
Title or Position: SECRETARY
Credential: D.P.M.
Phone: 610-678-4581